Provider Demographics
NPI:1760441760
Name:MCGUCKIN, JAMES FREDERICK JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
Last Name:MCGUCKIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1215
Mailing Address - Country:US
Mailing Address - Phone:267-405-9090
Mailing Address - Fax:
Practice Address - Street 1:4220 MARKET ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3007
Practice Address - Country:US
Practice Address - Phone:215-240-6007
Practice Address - Fax:215-240-6373
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4184852085R0204X
PAMD050322L2085R0204X
TNMD00000431182085R0204X, 2085R0204X
LAMD.2020132085R0204X
MDD623532085R0204X
NJ25MA051829002085R0204X
CAG879922085R0204X
NC94005802085R0204X
TXN17602085R0204X
WAMD000476252085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7012306Medicaid
PA0018439730003Medicaid
NJP00431753OtherRR MEDICARE
NJ877737ZC3BMedicare PIN
G30407Medicare UPIN
PA49685Medicare ID - Type Unspecified
PA0018439730003Medicaid
NJP00431753OtherRR MEDICARE
LA4N477DG27Medicare PIN
TN33736121Medicare PIN
WAG8881484Medicare PIN
LA4N477DH19Medicare PIN
NC2347351AMedicare PIN
NJ877737Medicare ID - Type Unspecified
NJ7012306Medicaid
TX8F21300Medicare PIN
NJ87737VBVMedicare PIN
TN3373612Medicare PIN